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Walkom: The downside to Ontario’s health-care reforms

Health Minister Deb Matthews&rsquo; idea of providing better quality health care at lower cost is a good one. The reality, however, is that deficit-obsessed governments focus far more on cost reduction than quality maintenance.

Minister of Health Deb Matthews was at the Board of Trade in Toronto on Monday to unveil the McGuinty government's plan to transform health-care for Ontario families. (Colin McConnell / Toronto Star) | Order this photo

Is the Ontario government serious about improving the province’s health-care system? Or are Health Minister Deb Matthews’ proposed reforms just cover for spending cutbacks? History is not encouraging.

On the face of it, Matthews’ still-vague plan, which she laid out in a speech Monday, sounds eminently sensible.

She says she wants to make it possible for frail, older people to stay in their own homes instead of using more expensive nursing homes.

To relieve the pressure on pricey hospitals, she wants to hand off simple kinds of medical procedures, such as cataract eye surgery, to cheaper non-profit clinics.

And she wants family-care physicians to make more house calls so sick, old people don’t have to spend hours in costly hospital emergency rooms.

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In theory this is all well and good. Advocates for the elderly have long pleaded for more home care spending. Many older people prefer their own homes to nursing homes. For some, regular visits by a nurse — or even help with housework — would make staying at home possible.

And non-profit specialty clinics? Studies show that dedicating specific resources to assembly-line forms of medicine like cataract or hip surgery does reduce wait times. Why not transfer some of these procedures from non-profit general hospitals to non-profit specialty clinics?

As always, however, the devil is in the details. Not all non-profit firms, for instance, are equally virtuous.

Take the non-profit health-care agency called ORNGE. It was set up by Dalton McGuinty’s Liberals in 2005 to handle the province’s air ambulance needs. But then the government quietly allowed ORNGE to establish for-profit satellite companies which focused on making money for its executives while skimping on the health-care services the agency was supposed to provide.

Matthews acted to end this embarrassment only after it was made public by the Star’s Kevin Donovan.

Nothing Matthews suggested this week is new. But change has been slow, largely because Queen’s Park has been reluctant to spend the necessary money.

In the case of home care, for example, the government’s emphasis has been on reducing costs — both by encouraging the use of low-paid, high-turnover staff and by trimming the time devoted to clients.

In the past, the government has offered financial sweeteners to physicians willing to do after-hours work. But now Matthews seems to be saying that doctors are paid too much. How then will she encourage them to make more house calls? At gunpoint?

Ontario has already seen theoretically sensible health-care reforms go badly awry. In the 1970s, it was argued that mentally-ill patients would do better if they lived in the community rather than psychiatric hospitals. And, for some, that was probably true.

But Ontario’s then Conservative government didn’t act until it faced a budget crisis. At that point, it closed psychiatric institutions wholesale and sent seriously mentally-ill patients to live in group homes, many of which proved to be grossly inadequate.

Similarly, in the late 1990s, another Ontario government undertook the theoretically sensible step of rationalizing hospital care. But the actual hospital closings, again designed to reduce costs, caused an uproar.

Certainly, Matthews’ idea of providing better quality health care at lower cost is a good one. Who can disagree? The historical reality, however, is that deficit-obsessed governments focus far more on cost reduction than quality maintenance.

To put it in specific terms: More home care would be welcome. But not at the expense of those who really do need Ontario’s already underfunded nursing homes.

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